Provider Demographics
NPI:1023193661
Name:LAIDLAW, ANDREA J (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:J
Last Name:LAIDLAW
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E MAIN ST
Mailing Address - Street 2:#190
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4191
Mailing Address - Country:US
Mailing Address - Phone:503-648-0859
Mailing Address - Fax:503-640-6364
Practice Address - Street 1:400 E MAIN ST
Practice Address - Street 2:#190
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4191
Practice Address - Country:US
Practice Address - Phone:503-648-0859
Practice Address - Fax:503-640-6364
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD74711223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR930719168OtherTID